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Social Work Tech Notes - Remember Hand-Written Progress Notes? A Social Worker's Tale of Technology and Cultural Change

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by Stephen P. Cummings, MSW, ACSW, LSW

Editor’s note: I am pleased to introduce Stephen Cummings, our new Social Work Tech Notes columnist. Stephen is well-versed in the world of tech and social work, and we are fortunate that he will be sharing his expertise with The New Social Worker readers. Welcome, Stephen!

     I was a new social worker in the early 2000s. I remember sweating through advanced practicum in a hospital setting. I was grateful for the placement I’d arranged—a rotation in an inpatient oncology unit at a large regional trauma hospital. I was fortunate to have a group of dedicated clinical social workers, willing to instruct and mentor me throughout the academic year. There was much to learn. I finally had the opportunity to practice interviewing skills I’d worked on in my MSW program’s skills laboratory. Despite the interventions we discussed in class, it was only when I walked into a patient’s room on my own that I could feel the difference between the preparation and active engagement. And despite the courses, one element was missing from my educational experience as I prepared for practice—the social work leadership role in the use of technology.

    The hospital setting is built on technology. The interdisciplinary team engages with patient care with it. It’s pervasive and easy to take for granted. For example, it’s common for X-rays to be visible at the patient’s bedside, no longer relegated to staffing rooms away from view. Patient vitals can be observed from a distance. Working in the ICU, I witnessed patient care that required cutting-edge technology that was managed with the highest competency.

    Technological advancements in this setting are accepted as part of the daily experience. However, 20 years ago, my social work practice was in the beginning stages of a massive professional undertaking—note-taking. I was witnessing the conversion from hand-written chart notes to patient records that could be written, accessed, and shared from anywhere. From my perspective, this was a natural, and much-needed, acknowledgment of technology use. I was just starting to take on-call shifts, which allowed me to stay at home until I was needed. I was available via pager. When I received a referral, I could access patient records via an encrypted online database. Even while I was working on a regular shift, I could review patient records and chart before morning rounds off the unit, in my office, away from distractions or “curbside consults.”

    It was not only progress; it was necessary. Besides, notes by hand were agonizing to write, took more time, and left a more static footprint. To read the hand-written note, you needed to be where the chart was located. Then the clinician would need to decipher a range of handwriting styles. This was not only impractical—if a hand-written chart note was misinterpreted, it could be potentially harmful to patients. A unified, dynamic charting system wasn’t folly. I saw this as a natural fit with best practice for clinical social workers.

    Among my social work colleagues, this was not a mutually shared perspective. The presence of computer terminals in the office and on the units presented a new world of barriers. How do you log in? How do you access the charting space? How do you confirm the note was entered? What happens if you need to change or add to the note? One staff member suggested at least one conspiracy: this was about keeping the Information Technology department busy, at the expense of a tried-and-true clinical practice. After all, one of the hallmarks of social work practice was keeping accurate records. From the perspective of at least a few of the social workers on staff, this was an affront to their practice.

    I remember one interaction well. It was after I’d presented to our social work staff to highlight the features of the new charting software. I was recruited to help make the case for this new electronic charting system to the social work staff. I guess administration members thought, perhaps, that I would be able to present bilingually—the language of the new technology application and the language of social workers. I presumed this would be an easy sell. After all, I figured everyone would naturally be supportive of the qualities this change would provide. After the presentation, I was cornered by a colleague who was visibly irate. I was informed this was not only a bad idea; this new system would reduce productivity and increase harm to patients—everything I had just stated it was designed not to do.

    I share this story not to retroactively complain about my fellow clinical social workers from a simpler time. As a new social worker at that time, I made a presumption about the readiness of the social workers I worked with every day; it wasn’t fear or ignorance, but rather a natural reaction to the changes being forced upon them. Perhaps, as a new social worker hoping to make an impression, I was more inclined to throw my enthusiasm behind the thing I felt most comfortable with—the up and coming technology platform—rather than address, as a new staff member, the concerns of my senior colleagues.     

     What could I have done? For a start, open a forum with a chance for people to talk about what they knew, and what they didn’t know, about the new technological platform that was being launched. On reflection, it became clear that systemic change was seen by some members on the staff as an affront to their practice. Their concerns were real, and these concerns had not been validated, or even acknowledged. In this environment, in this case, I reflect on steps I could have taken to help prepare for this shift:

    In my current professional role, I’m asked to talk to social work clinicians about the current state of technology use in social work practice. This is the case in particular this year, as two major documents, the updated Standards for Technology and Social Work Practice, and the updated NASW Code of Ethics, have been published recently. Often, these requests to facilitate discussion involve what professional social workers are rightfully afraid of—concern over dual relationships in social media, understanding best practices for data security, and using videoconferencing platforms for counseling, to name a few. These are important concerns to address, but it’s not the only way to frame how social workers engage in technology.

    One of the strengths of social work practice is our ability to be leaders in technology use. The language of our updated standards document on technology emphasizes the need for reasonable competence. In developing new programs or creating new interventions involving technology, we are strongest when we aren’t just competent, but are emergent leaders.

Stephen Cummings is a clinical assistant professor at the University of Iowa School of Social Work, where he is the administrator for distance education.

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